What Does Mood-Incongruent Versus Mood-Congruent Mean?

A Way of Describing Psychotic Features in Bipolar Disorder

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You may have heard the terms mood-incongruent or mood-congruent, but what do these terms mean in psychology, and specifically in connection with bipolar disorder. 

Defining Mood-Incongruent 

Incongruent means "conflicting," so your symptoms are mood-incongruent if they are not consistent with your current mood or they are at odds with current circumstances. For example:

  • Laughing when your pet dies.
  • Believing you receive messages from God without having delusions of being a prophet or saint, etc.

    Defining Mood-Congruent 

    Congruent means "agreeing," so your symptoms are mood-congruent when they are consistent with your mood and circumstances, such as the disorder with which you have been diagnosed. For example:

    The Difference Between Mood and Affect

    On a side note, though the terms mood and affect are often used interchangeably, they don't mean quite the same thing, so it's a good idea to understand their difference.

    Mood describes feelings or emotions that may be experienced over a long period of time, while affect refers to the current emotional response of the mood.

    Another way to think of it: Mood is like a season and affect is like the weather during that season.

    How Does Mood Congruence or Incongruence Relate to Bipolar Disorder?

    Not everyone with bipolar disorder deals with incongruent moods, but if you do, you're likely having a psychotic episode and your bipolar diagnosis may include the term "with psychotic features."

    What is Psychosis?

    Psychosis is a break from reality that can happen in bipolar disorder with a manic episode or sometimes with a depressive episode, but never with a hypomanic episode. Psychosis involves hallucinations and/or delusions. If you are experiencing psychotic symptoms, your doctor will label your symptoms as either mood-congruent or mood-incongruent.

    Psychotic symptoms only occur during mood episodes, not at other times.

    Mood-Congruent and Mood-Incongruent Hallucinations

    Most people tend to associate hallucinations with schizophrenia, but they can happen in bipolar disorder, as well, when there are psychotic features associated with the illness. Hallucinations are hearing, seeing, smelling or tasting things that aren't real.

    A mood-congruent hallucination in a depressive episode would involve depressive themes such as guilt or sadness. For example, hearing a voice that tells you that you're worthless.

    In a manic episode, a mood-congruent hallucination would involve grandiosity, like seeing the president in your living room. 

    A mood-incongruent hallucination in a depressive episode would not have the typical associations with guilt, sadness, and death that depressive episodes have. So, for instance, if you are hearing a voice that is telling you that you've been chosen for some special task, that's incongruent with your depressed mood.

    In a manic episode, a mood-incongruent hallucination would be the opposite, perhaps a voice you hear that says that you should feel guilty for something.

    Mood-Congruent and Mood-Incongruent Delusions

    Delusions are firmly held beliefs that are not true and not based in reality.

    An example of a mood-congruent delusion during a manic episode would be believing that you hold special knowledge that will solve the world's problems. Because mania tends to involve feelings of grandiosity and self-importance, this delusion fits the mood.

    An example of a mood-congruent delusion during a depressive episode would be believing that you or everyone around you is dead, which correlates with the depressive themes of death and sadness.

    Mood-incongruent delusions involve having a delusion that doesn't fit with your mood. In mania, they could come across as believing everyone is out to get you.

    In depression, perhaps believing that everyone is out to get you, but that you don't deserve it, which is the opposite of the guilt and rejection typically felt in a depressive mood.

    The Outlook for Mood-Incongruent Symptoms

    Studies suggest that it's harder to recover when your symptoms involve mood-incongruent psychotic features. Further, these symptoms may overlap with schizophrenia and/or schizoaffective disorder.

    Sources:

    Blom JD. A Dictionary of Hallucinations. Springer Science + Business Media, 2010.

    Cutler JL. Psychiatry: Third Edition. Oxford University Press, New York, NY, 2014.

    Goes FS. et. al. Mood-Incongruent Psychotic Features in Bipolar Disorder: Familial Aggregation and Suggestive Linkage to 2p11-q14 and 13q21-33. American Journal of Psychiatry 2007 Feb;164(2):236-47.

    The Royal Children's Hospital Melbourne. (2016). Mental State Examination.

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